Balancing Medical School Training: Addressing Doctor Distribution in Australia

1. Getting the Balance Right How Can Medical Schools Help? Brendan Crotty

2. Australian Medical Graduates 1999-2014 MTRP 19th Report 2016

3. Australian Medical Graduates 2014-2019 MTRP 19th Report 2016

4. Graduation December 2011

5. Getting the Balance Right Issues surrounding the predicted oversupply of doctors and the consequences for the distribution of doctors in Australia, including the role of IMGs in rural areas

6. Rural and regional health Needs Burden of chronic disease / disability ageing population with multiple chronic diseases epidemics of obesity and diabetes cancer degenerative disease mental health disorders Continuing regional/rural w-force shortages We need to train generalists!

7. Generalist Specialists and Subspecialists General Practitioners Procedural GPs

8. Deakin Clinical Schools Deakin Clinical Schools • Geelong • Warrnambool • Ballarat • RCCS More medical students per capita outside Melbourne than in Melbourne Expansion of Monash and UoM RCS’s UND students in Ballarat

9. The Australian HIGHER EDUCATION Students not convinced of need for Murray Darling Medical School

10. Expansion of Victorian Intern Positions More interns per capita outside Melbourne than in Melbourne High achievers choosing internships in Melbourne Regional interns leave for vocational training

11. Australian Medical Graduates 1999-2014 Vocational Training Bottleneck MRTP 19th Report 2016

13. MABEL Policy Brief 3, 2017

14. Key findings • The goal of policy should be to: • Continue to select medical students with rural backgrounds and facilitate rural immersion options in undergraduate training • Enhance the number of trainees in general practice and other generalist specialties • Ensure more vocational training is undertaken in rural settings • Further develop workforce capacity, including accessible locum support and PD • Enhance the ability of doctors in rural communities to continue practising and undertake advanced skills training • Target financial incentives more carefully • Develop regional specialist service hubs • Continue, though with likely decreasing reliance, the 10-year moratorium and 457 visas

15. MYEFO 15-12-15 Integrated Rural Training Pipeline for Medicine • Up to 30 new regional training hubs at RHMT sites. Over $14 million per year to universities through a competitive process • Targeted STP expansion in rural areas – 50 new places in 2017 and 50 in 2018 • Rural Junior Doctor Training Innovation Fund to enable rural-based interns to spend time in rural general practice

16. General surgery training: South west regional hub Geelong, Ballarat, Warrnambool, Hamilton, Colac • 12 accredited training posts • Surgical trainees based in the region for the most of their training • Offer rotations to metropolitan training hubs • …….. only if reciprocal subspecialty rotations are available to SWRH trainees.

17. Victorian Regional Medical Training Networks

19. Victorian Regional Medical Training Networks • Four regional training networks • Use RCS facilities and IT • Trainees will complete the majority of their (generalist) p/g training in the region • Integrated hospital-based GP training • Network staff: accreditation and development of programs • Training provided by regional clinicians

20. Integrated Rural Training Pipeline for Medicine ‘New places (and hubs) will be restricted to ASGC RA 2-5 areas and should be designed to enable a specialist trainee to complete the majority of their training within a rural region, with only limited metropolitan rotations where this is necessary to meet fellowship standards.’ • Is this possible with 26 hubs? • Gold Coast, Newcastle, Wollongong and Geelong excluded • ‘

21. Thank you